Understanding domestic care workers’ health through the lens of labour exploitation as a social determinant of health: Evidence from Brazil, Colombia and UK
1
Humanitarian and Conflict Response Institute, University of Manchester, Manchester, United Kingdom
2
Centre for Gender and Disasters, University College London (UCL), London, United Kingdom
3
Universidade Federal de Santa Catarina, Florianopolis, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1341
ABSTRACT
BACKGROUND:
COVID-19 brought attention to the care sector, yet domestic workers providing direct (e.g. bathing) and indirect care (e.g. cleaning) in private homes remain overlooked1. Occupational health literature on this highly feminised and racialised workforce is scarce. Domestic workers have long been exposed to poor employment and working conditions, labelled exploitative2. In public health, labour exploitation has been examined through two main lenses: Human Rights lens focused on modern slavery; or Social Determinants of Health (SDH) focused on structural issues3. Our study assessed labour conditions and health among domestic workers using Boufkhed et al.’s (2022)3 framework, conceptualising labour exploitation as an SDH, and integrating the two lenses.
METHODS:
We conducted an exploratory mixed-methods study in Brazil, Colombia, and UK (2023–2025) using non-probabilistic sampling. Fifteen focus groups (FG) were conducted with 134 participants, guided by the framework dimensions (social protection and rights; finance and migration; health and safety; personal security/abuse) and health prompts. Findings4 informed the co-design of an online survey completed by 436 respondents.
RESULTS:
Participants were predominantly women (>95%) and racialised (≥70%). FG highlighted poor social protection, and two-thirds of workers surveyed in Brazil and Colombia and three-quarters in UK had no contract. Low pay was a central discussion, and the survey showed 31% incurring debt for basic needs. Injuries and chemical exposures were key health and safety concerns, reported by 20% of surveyed workers. All FG denounced abuse, and 23% of surveyed workers reported verbal, physical, or sexual abuse in the previous month. Mental health concerns (e.g. anxiety, depression) dominated discussions, with common physical pain. However, survey respondents reported relatively good self-rated health, raising measurement concerns.
CONCLUSIONS:
Domestic workers’ exposure to severe workplace hazards and exploitation, including widespread violence, needs urgent attention from public health researchers and policymakers. Better health measures are needed to capture this populations’ experiences.
COVID-19 brought attention to the care sector, yet domestic workers providing direct (e.g. bathing) and indirect care (e.g. cleaning) in private homes remain overlooked1. Occupational health literature on this highly feminised and racialised workforce is scarce. Domestic workers have long been exposed to poor employment and working conditions, labelled exploitative2. In public health, labour exploitation has been examined through two main lenses: Human Rights lens focused on modern slavery; or Social Determinants of Health (SDH) focused on structural issues3. Our study assessed labour conditions and health among domestic workers using Boufkhed et al.’s (2022)3 framework, conceptualising labour exploitation as an SDH, and integrating the two lenses.
METHODS:
We conducted an exploratory mixed-methods study in Brazil, Colombia, and UK (2023–2025) using non-probabilistic sampling. Fifteen focus groups (FG) were conducted with 134 participants, guided by the framework dimensions (social protection and rights; finance and migration; health and safety; personal security/abuse) and health prompts. Findings4 informed the co-design of an online survey completed by 436 respondents.
RESULTS:
Participants were predominantly women (>95%) and racialised (≥70%). FG highlighted poor social protection, and two-thirds of workers surveyed in Brazil and Colombia and three-quarters in UK had no contract. Low pay was a central discussion, and the survey showed 31% incurring debt for basic needs. Injuries and chemical exposures were key health and safety concerns, reported by 20% of surveyed workers. All FG denounced abuse, and 23% of surveyed workers reported verbal, physical, or sexual abuse in the previous month. Mental health concerns (e.g. anxiety, depression) dominated discussions, with common physical pain. However, survey respondents reported relatively good self-rated health, raising measurement concerns.
CONCLUSIONS:
Domestic workers’ exposure to severe workplace hazards and exploitation, including widespread violence, needs urgent attention from public health researchers and policymakers. Better health measures are needed to capture this populations’ experiences.
| eISSN: | 2654-1459 |
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